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Musculoskeletal Pathophysiology > Ankle and Foo > Flashcards

Ankle and Foo Flashcards

1
Q

What is Talipes Equinovarus?

A

Clubfoot

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2
Q

What is the position of the calcaneus with clubfoot?

A

varus

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3
Q

What is the forefoot position in clubfoot?

A

adduction

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4
Q

What is the position of the midtarsal in clubfoot?

A

Supination

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5
Q

What happens to the joint capsule in clubfoot?

A

thickened

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6
Q

Who gets clubfoot more often?

A

Males 2:1

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7
Q

How many cases of clubfoot are bilateral?

A

1/3-1/2

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8
Q

What is the management of eqinovarus?

A 
weekly casting (6 wks)
splints (8 wks)
AFO or corrective boot (until walking)
Night splint (1 more year)
Straight lace shoes (2 years)
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9
Q

What % of those with equinovarus respond in the first 3-4 months?

A

40%

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10
Q

What % of those with equinovarus need soft tissue surgery?

A

60%, usually a muscle release

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11
Q

If the pt is not treated for equinovarus by 5 years what will they need?

A

arthrodesis, usually wait until they are > 10 years old

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12
Q

What is pes cavus?

A

Structural high medial and lateral arch resulting in a rigid foot

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13
Q

What can pes cavus be associated with?

A

May be associated with a neurological disorder

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14
Q

Is pes cavus familial?

A

yes

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15
Q

What is an associated pathology with pes cavus?

A

Claw toes

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16
Q

What is the Rx for pes cavus?

A

adaptive shoes

specialized arch supports

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17
Q

What is pes planus?

A

flat feet, congenital or acquired. If you dont have adequate dorsiflexion you will pronate prematurely.

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18
Q

A congenital pes planus is more or less common? more or less rigid?

A

less common. More rigid

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19
Q

How is pes planus acquired?

A

compensation for other bony abnormalities, weakness or neuromuscular problems

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20
Q

What is Hallux limitys?

A

1st MTP restriction usually due to OA or Jt capsule.

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21
Q

How much MTP extension do you need for push off?

A

65 degrees

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22
Q

What is the Rx for Hallux limitus?

A

adaptive shoues (rocker sole shoes), joint mobs (if capsular)

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23
Q

What is Hallux rigidus?

A

complete bony ankylosis, may require resection arthroplasty

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24
Q

What is hallux (abducto)valgus?

A

1st toe laterally angulated at MTP joint associated with bunion formation

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25
Q

Who gets hallux (abducto)valgus more?

A

Females>males, usually assocated with poorly fit shoes

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26
Q

What is a Keller operation?

A

Resection of proximal half of the proximal phalanx and excision of prominent medial portion of met head

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27
Q

What is a hammer toe?

A

MTP extended, PIP flexed,

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28
Q

How are hammer toes caused?

A

Intrinsic weakness or imbalances
fallen transverse arch
poor shoe fit

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29
Q

What is a claw toe?

A

MTP extended, PIP flexed, DIP extended

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30
Q

What is a mallet toe?

A

Flexed DIP, usually due to poor shoes

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31
Q

What is a mortons toe?

A

Long 2nd metatarsal or short 1st metatarsal elading to excessive pressure under 2nd met head

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32
Q

What do you see sometimes with a mortons toe?

A

abnormal pronation

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33
Q

What is Mortons neuroma?

A

Nerve inflammation usually between 3rd and 4th metatarsals

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34
Q

Who gets mortons neuroma more?

A

Females>males

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35
Q

What are the symptoms of mortons Neuroma?

A

burning pain, toe numbness

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36
Q

What is the Rx for Mortons neuroma?

A

Roomier shoes (limit heels)
Corticosteroid injection
Orthosis
Excision if conservative failure

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37
Q

What are the most common type of ankle sprain?

A

Lateral (inversion sprain)

38
Q

What is a medial sprain?

A

eversion sprain

39
Q

What is a high ankle sprain?

A

syndesmotic sprain. excessive ankle dorsi-flexion and external rotation of the shin

40
Q

What are the signs/sxs of an ankle sprain

A 
Edema
eccyhmois
painful gait
tender to palpation
laxity
41
Q

What is a grade 1 sprain?

A

mild-stable. single ligament stretch or minor tear, usually ATFL

42
Q

What is a grade 2 sprain?

A

moderate, some instability. Full ATFL tear or partial of ATFL and CFL

43
Q

What is a grade 3 sprain?

A

Severe, unstable. Complete tear of ATFL, CFL and ant. capsule. may need operative repair

44
Q

1st degree high ankle sprain?

A

only a few ligament fibers are damaged within the interosseous membrane

45
Q

2nd degree high ankle sprian?

A

more extensive damage to the interosseous membrane with some widening of the T-F joint

46
Q

3rd degree high ankle sprain?

A

complete rupture of the interosseous ligament with gross widening of the T-F joint and possible joint dislocation

47
Q

PT considerations post ankle sprain?

A

protect from eversion/inversion
restore active motion painfree
restore timing and coordination and strength

48
Q

What is the mechanism of an Achilles tendon rupture?

A

violent contraction of gastroc, usually 1-2 inches above insertion into calcaneus (if complete)

49
Q

What are the signs/sxs of an Achilles tendon rupture?

A

Edema, ecchymosis, PF grossly impaired

+ thompson test

50
Q

What is the Rx of a total Achilles rupture?

A

surgical repair then casted in PF for 4-6 weeks (LLC 2 wks then SLC for 3-6 wks)

51
Q

What is Achilles tendinitis usually 2ndary to?

A

training errors
uphill running
rigid shoes
tight gastrocs

52
Q

Rx for Achilles tendinitis?

A

RICE, heel lift, check for abnormal foot position, length of muscle

53
Q

What is Retrocalcaneal Bursitis? What is it assocaiated with?

A

Inflammation of bursa anterior to gastroc tendon but posterior to talus and calcaneus. excessive pronation, poor shoe fit or padding in heel area

54
Q

What is plantar fascitis?

A

inflammation of plantar apeneurosis

55
Q

How do you get plantar fascitis?

A

repetitive mecrotrauma associated with rigid or excessively mobile foot AND/OR excessive pronation

56
Q

What is associated with plantar fascitis?

A

May have heel spur at medial calcaneal tubercle

57
Q

What are the signs/sxs of plantar fascitis?

A

plantar foot pain on arising in AM or after sitting for a while
may have crepitus in soft tissues of the facia

58
Q

What is the Rx for plantar fascitis?

A

treat inflammation, night splints in DF, foot orthosis to correct biomechanical faults

59
Q

What is MTSS?

A

Medial tibial stress syndrome. Periosteal irritation or stress reaction of medial border of tibia along post. Tib or Soleus origin

60
Q

What can cause MTSS?

A

excessive pronation, tight muscles

61
Q

What are the signs/sxs of MTSS?

A

painful gait, tender along medial/posteriomedial shin

62
Q

What do you need to differentiate MTSS from?

A

tibial stress fx via bone scan

63
Q

What are some sxs of Tibial stress fx?

A

Night pain
Specific spot pain
Sensitive to US

64
Q

What causes a Tibila stress fx?

A

Overuse injury often with poor mechanics

65
Q

Acute Compartment syndrome cause?

A

direct blow

66
Q

Acute Compartment syndrome length of symptoms?

A

hours to days

67
Q

Acute Compartment syndrome area of involvement?

A

any muscle group

68
Q

Acute Compartment syndrome method of diagnosis?

A

clinical symptoms or compartmental pressures

69
Q

Acute Compartment syndrome treatment?

A

EMERGENCY FASCIOTOMY

70
Q

Chronic Compartment syndrome type of injury?

A

usually no trauma

71
Q

Chronic Compartment syndrome length of symptoms?

A

weeks to months

72
Q

Chronic Compartment syndrome area of involvement?

A

usually anterior or lateral compartment of lower leg

73
Q

Chronic Compartment syndrome method of diagnosis?

A

compartmental pressures or stress thallium testing

74
Q

Chronic Compartment syndrome treatment?

A

RICE or possible elective fasciotomy if no response to conservative therapy

75
Q

What muscle is usually the culprit in anterior compartment syndrome?

A

Anterior tib, 2ndary irritation and swelling of muscle causing ischemia and compression of neurovascular strutures

76
Q

What is the timeframe for return for a fasciotomy?

A

return to exercise after 3 weeks

77
Q

What is tarsal tunnel syndrome?

A

A compression of the tarsal tunnel in the foot

78
Q

What are the symptoms of tarssal tunnel?

A

pain burning, paresthesiae to medial and plantar surface of foot

79
Q

How is tarsal tunnel aggravated?

A

eversion, DF and excessive pronation

80
Q

What is a distal Tib-Fib fx usually secondary to?

A

MVA

81
Q

Why does the lower 1/3 shaft of a the distal fib heals slower?

A

poor vascularity

82
Q

How is a distal Tib-fib fx treated?

A

Closed reduction if stable; ORIF with intramedullary nail if unstable

83
Q

What is a type A ankle fx on the Denis-Weber Classification scale?

A

fx below the ankle joint

84
Q

What is a Type B ankle fx on the Denis-Weber Classification scale?

A

Fx at the level of the joint, with tib-fib ligaments usually intact

85
Q

What is a Type C ankle fx on the Denis-Weber Classification scale?

A

Fx above the joint level which tears the anterior and posterior syndesmotic ligaments

86
Q

How would you fx the medial malleolus?`

A

adduction (inversion) injury. With or without lateral ligaments

87
Q

How would you fx the lateral malleolus?

A

Abduction and ER (with or without medial ligaments)

88
Q

What is a tibial pilon Fx?

A

Verticle compression fx of distal tibia

89
Q

How would you treat a severe Tibial pilon fx?

A

ORIF or arthrodesis

90
Q

What are talar injuries usually 2ndary to?

A

high impact

91
Q

What can lead to avascular necrosis of the talar dome?

A

3rd degree talar neck fx

Musculoskeletal Pathophysiology (14 decks)

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